COVID-19 Clinical Resource Guide

2019 novel coronavirus (COVID-19) is a new strain of a virus causing an outbreak of respiratory illnesses. The illness was first detected in Wuhan, China, in December 2019, with cases now identified in the United States and multiple other countries. For the most current statistics, please refer to the Johns Hopkins Coronavirus Resource Center for Coronavirus COVID-19 Global Cases tracking.

Overview

The COVID-19 is from a large family of human coronaviruses named for crown-like spikes on their surface with the main subgroupings classified as alpha, beta, gamma, and delta. First identified in the 1960s, there are seven coronaviruses that can infect humans.1

229E (alpha coronavirus)

NL63 (alpha coronavirus)

OC43 (beta coronavirus)

HKU1 (beta coronavirus)

MERS-CoV (beta coronavirus)

SARS-CoV (beta coronavirus)

2019 novel coronavirus

Coronavirus infections range from the common cold to the rare and deadly varieties of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The MERS-CoV, SARS-CoV, and COVID-19 are examples of virus evolution that began with animals and have now become a threat to humans.

Signs and symptoms

If exposure to COVID-19 and/or fever or other symptoms occur, a healthcare provider should be contacted for medical advice.

Person-to-person spread occurs similarly to influenza and other respiratory illnesses. The incubation period is between two and 14 days post-exposure, with symptoms ranging from absent or minimal to acute, severe respiratory complications that may result in death.

Acute signs and symptoms include:

Fever (subjective or confirmed)

Chills

Cough

Shortness of breath or difficulty breathing

Repeated shaking with chills

Muscle pain

Headache

Sore throat

New loss of taste or smell

Severe symptoms may involve:

Coughing with mucus production

Increasing shortness of breath

Chest pain or tightness

The illness can easily progress to infection causing pneumonia, severe acute respiratory syndrome, kidney failure and death. Those with the highest risk include anyone with cardiac and respiratory diseases or weakened immune systems, as well as infants and older adults. It is also not unusual for the immunocompromised patient to experience atypical symptoms such as hemoptysis and diarrhea.2,3

Transmission

How COVID-19 Spreads

There is much to learn about the newly emerged COVID-19, including how and how easily it spreads. Close contact can occur while caring for a patient or infected person, including:

Being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.

Having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.

Transmission occurs when a non-infected person comes in contact with airborne or surface droplets of an infected person (for example, through coughing, sneezing or touching).

The virus remains a serious public health threat. Recommendations for health care workers include standard, contact and airborne precautions with use of eye protection, if the following occurs and COVID-19 is suspected:

Coughing and sneezing

Close personal contact

Touching objects and surfaces that have the virus and touching mouth, nose or eyes

Transmission through fecal contamination is also possible, although rare.

The CDC expects widespread transmission of COVID-19 in the United States to occur in the coming months with most of the U.S. population being exposed. Protective measures are recommended in order to keep self and others free from illness.

Diagnosis

Confirmatory diagnostic laboratory testing for COVID-19 has been delivered to state and local public health departments from the CDC. Commercial manufacturers are also developing quick test kits for medical providers. While the CDC has guidance for who should be tested for COVID-19, decisions are made at the discretion of state and local health departments and/or individual clinicians.

Specimens should be collected as soon as possible once a patient under investigation (PUI) is identified, regardless of the time of symptom onset. Notification to local health departments should begin immediately if the COVID-19 is suspected. The CDC’s Emergency Operations Center can assist with specimen collection, storage and shipping, including after hours and on weekends and holidays, if needed.

For initial diagnostic testing for COVID-19, the CDC recommends collecting and testing upper respiratory tract via a nasopharyngeal (NP) specimen for swab-based SARS-CoV-2 testing. When collection of a nasopharyngeal swab is not possible, the following are acceptable alternatives:

An oropharyngeal (OP) specimen collected by a healthcare professional, or

A nasal mid-turbinate (NMT) swab collected by a healthcare professional or by onsite self-collection (using a flocked tapered swab), or

An anterior nares specimen collected by a healthcare professional or by onsite self-collection (using a round foam swab).

For NS, a single polyester swab with a plastic shaft should be used to sample both nares. NS or NMT swabs should be placed in a transport tube containing either viral transport medium, Amies transport medium, or sterile saline.

If both NP and OP swabs both are collected, they should be combined in a single tube to maximize test sensitivity and limit testing resources.

The CDC is not recommending antibody testing for diagnosing acute infection as nucleic acid or antigen tests are needed for diagnosis of a current infection.

The following prioritization criteria for evaluating and testing suspected cases of COVID-19 in the U.S. is recommended:4

High Priority

Hospitalized patients with symptoms.

Healthcare facility workers, workers in congregated living areas, and first responders with symptoms.

Patients in long-term care facilities or other congregate living settings including correctional/detention facilities and shelters, with symptoms.

Persons identified by public health officials or clinicians as high priority

Persons without symptoms prioritized by health departments or clinicians.

Testing for healthcare personnel may be considered if there has been exposure to a person with suspected COVID-19, even without laboratory confirmation. Due to the frequency of extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel.

Treatment

Currently, there is no vaccine or specific antiviral treatment that prevents COVID-19 but vaccine trials are in progress.4,5 For those infected, supportive care for symptom relief and the necessary treatment to support vital organ function in severe cases is indicated. Supportive measures include over-the-counter medication, rest, and fluids.

Prevention and transmission-reduction strategies include the following:6,7,8,9

Wash hands, preferably with soap and water for 20 seconds and use hand sanitizer if soap is not available.

Avoid touching face, nose, or mouth prior to handwashing.

Avoid close contact with those who are ill and practice social distancing.

Clean and disinfect surfaces.

Cover coughs and sneezes.

Stay home when ill.

Wear a surgical mask when possible and evaluate suspected patients in a private room or a reverse isolation room for airborne infections.